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Focused Cryosurgery Preserves Potency in Prostate Cancer Patients

CHICAGO (Reuters Health) Nov 28 - Focused cryosurgery for ablation of a single prostate lesion is a safe alternative to nerve-sparing prostatectomy, with little to no effect on sexual potency, according to study findings presented at the 87th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

Dr. Gary M. Onik, director of surgical imaging at the Center for Surgical Advancement, Florida Hospital Celebration Health, Celebration, Florida, explained that because cryosurgery "causes no trauma at all to the nerve," the procedure can preserve potency "even when we remove one nerve, because the remaining nerve is untouched, fine."

He said that nerves and other anatomy, including the rectum, are spared because "we manipulate the lesion by injecting saline into the surrounding tissue before freezing. This effectively creates wider margins."

Dr. Onik reported results from a series of nine patients. The men were all high-risk patients with a prostate-specific antigen of more than 10, a Gleason score of at least 7 and/or T2 lesions. The age range was 55 to 70.

"Seven of the nine men have retained full potency," Dr. Onik reported. Moreover, the procedure was done on an outpatient basis and the men were able to return to work in 5 days. "That compares with weeks of recovery after surgery, including possibly 6 weeks of daily radiation," Dr. Onik said.

"All of the patients have stable PSA, and six of the men have had negative biopsies," Dr. Onik said. There was no incontinence associated with the procedure.

While two men did not retain potency, cryosurgery was "a successful cancer treatment for them," he said. In one man, the first patient in the series, "both nerves were frozen. We didn't intend to do that, but we were still learning," said Dr. Onik. The other man had a number of comorbidities, including a previous prostate surgery that contributed to impotence.

Dr. Onik told Reuters Health that the procedure is much less costly than surgery, and "cryosurgery is already FDA-approved, so this option is available right now." Although high-risk patients were enrolled in the series, Dr. Onik said the greatest potential for focused cryosurgery is "for men who are in that middle group, the watchful waiting patients. Why not offer them a treatment rather than waiting for the cancer to progress?"

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